Provider Demographics
NPI:1902383987
Name:ST. THOMAS DIALYSIS CENTER, INC.
Entity Type:Organization
Organization Name:ST. THOMAS DIALYSIS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDEL
Authorized Official - Middle Name:ALANZO
Authorized Official - Last Name:CHINNERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA, HCM
Authorized Official - Phone:703-930-0046
Mailing Address - Street 1:8268 CROWN BAY CENTER
Mailing Address - Street 2:
Mailing Address - City:ST.THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8268 CROWN BAY CENTER
Practice Address - Street 2:
Practice Address - City:ST.THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:UM
Practice Address - Phone:340-776-1800
Practice Address - Fax:340-776-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment